Thursday, April 28, 2016

Brian Hutchinson: Finding used drug needles in public spaces has become the new normal for Vancouver

Dirty needles found near children's playground in Vancouver's West End

VANCOUVER
— You have found a used needle, in one of the last places you ever
expected — or wanted — to see one. On the playground. Inside the
schoolyard. On the beach. Now what?

Shiloh Sukkau was shocked at
first. Then resigned. Now she’s upset. Same with Joel Reid and Jessica
Leung, and now they’re speaking out.

Three people, unknown to each
other, living and working in different parts of the city. Finding dirty
needles in public places. Kids’ spaces.

In this permissive city,
where open drug use is sadly common, people have finally reached a
boiling point. They’re fed up with finding dangerous materials left
behind by intravenous drug users, whose numbers in Vancouver exceed
12,000, according to local health authorities.

Dirty needles, called “sharps,” along with cooking gear, water ampoules and rubber ties are the most common detritus.

The
problem isn’t confined to Vancouver’s drug-infested Downtown Eastside.
Used needles with trace amounts of heroin, cocaine, crystal
methamphetamine, prescription opioids and blood are turning up across
the city.

On one Vancouver street corner, residents were recently
confronted with discarded sharps and, on a wall next to them, the image
of a happy face, drawn in blood.

Here’s the brutal irony, an
unintended consequence. Millions of needles are handed out in Vancouver
every year, more than in any other Canadian city. Free needle exchanges
funded by taxpayers and private donors are considered an effective form
of harm reduction; clean, disposable “rigs” can help prevent the spread
of such diseases as HIV and hepatitis.

Most of the used needles
from exchange programs are collected and disposed of properly. But every
year, more than 100,000 needles are carelessly discarded outside,
creating hazards for the rest of us. Last year, the number of needles
recovered outside was a staggering 250,732, according to Vancouver
Coastal Health.

Shiloh Sukkau is a young mother with an
eight-year-old child attending school in Vancouver’s West End, adjacent
to the downtown core. On Saturday, she found a used needle lying in a
children’s garden that she and other parents built in a city park. Her
daughter’s school, Lord Roberts Annex, takes up about one-quarter of the
same block.

Sukkau had previously found needles left in and
around the schoolyard. On each occasion she called a local
social-service agency, the Portland Hotel Society (PHS), for help.

The
PHS has a needle exchange and recovery program and will send someone to
collect used rigs from city parks and other places. The City of
Vancouver, the Vancouver Park Board and other agencies also offer
needle-recovery programs and daily “sweeps.” Clearly, though, these
efforts aren’t enough.

It’s really upsetting, especially because I’ve been trying to encourage … children to use the (garden) space

For
Sukkau, finding a needle in the school’s outdoor garden plot was a
tipping point. “It’s really upsetting, especially because I’ve been
trying to encourage other parents, teachers and children to
use the (garden) space,” she says. “Now I’m not sure it’s a good idea.”
The
morning after her discovery, Sukkau’s partner found eight more needles
in the same garden, which children had recently planted with vegetables.

Enough,
they said. Sukkau went public this week, contacting media and local
politicians, asking why residents are forced to deal themselves with
Vancouver’s drug-use problem. With few exceptions, no one in a position
of authority or elected office got back to her.

Joel Reid teaches
music at a Montessori school not far from Vancouver’s False Creek. He
often takes his young students to a nearby park but first, he has to
inspect the place for needles.

“It’s become a hot spot,” Reid says.

He
has also encountered people shooting up outside his school; in those
cases, he asks the drug users to move on. “They are very compliant, most
of them,” says Reid.

Fortunately, he’s not aware of any
needle-related injuries sustained by students. “The kids are pretty
aware. I’ll show them a needle if I find one, and warn them not to touch
one if they find one themselves.”
Jessica Leung and her family
moved to an Eastside neighbourhood last year. She finds discarded
needles as many as four times a week. “Places that families frequent are
being overrun with sharps,” she says.

The greater, underlying problem, she feels, is “prolific drug use.”

Like
Sukkau and Reid, she’s found such agencies as the PHS helpful at
collecting sharps. But the situation persists, and, she says, it’s
getting worse.

Some have suggested installing plastic needle
disposal boxes on street corners, in parks and inside public washrooms.
Leung and the others aren’t convinced they would solve anything.
Would
drug users who currently drop their needles on the ground suddenly
change their behaviour and put their needles safely inside a box? Would a
homeowner want a needle box placed outside their house? Fat chance of
that.

There is no simple solution. In Vancouver, scattered, dirty
needles are approaching “normal” status, sad facts of city life. It
seems we’re stuck with that.

A new call to action has been released from scientists around the world, reflecting "a growing consensus among experts that frequent cannabis use can increase the risk of psychosis in vulnerable people and lead to a range of other medical and social problems," according to the The Guardian.

Researchers now believe the evidence for harm is strong enough to issue clear warnings, said the article. For example, Sir Robin Murray, professor of psychiatric research at King's College London, stated:

"It's not sensible to wait for absolute proof that cannabis is a component cause of psychosis. There's already ample evidence to warrant public education around the risks of heavy use of cannabis, particularly the high-potency varieties. For many reasons, we should have public warnings."

Estimates suggest that deterring heavy use of cannabis could prevent 8 to 24% of psychosis cases handled by treatment centers, depending on the area. In London alone, where the most common form of cannabis is high-potency marijuana (or "skunk" as it is sometimes called in the United Kingdom), avoiding heavy use could avert many hundreds of cases of psychosis every year.

"It is important to educate the public about this now," said Nora Volkow, director of the US National Institute on Drug Abuse (NIDA). "Kids who start using drugs in their teen years may never know their full potential. This is also true in relation to the risk for psychosis. The risk is significantly higher for people who begin using marijuana during adolescence. And unfortunately at this point, most people don't know their genetic risk for psychosis or addiction."

Ian Hamilton, a mental health lecturer at the University of York, said more detailed monitoring of cannabis use is crucial to ensure that information given out is credible and useful. Most research on cannabis, particularly the major studies that have informed policy, is based on older low-potency cannabis resin, he points out. "In effect, we have a mass population experiment going on where people are exposed to higher potency forms of cannabis, but we don't fully understand what the short- or long-term risks are," he said.

Prof Wayne Hall, director of the Centre for Youth Substance Abuse Research at the University of Queensland, said that while most people can use cannabis without putting themselves at risk of psychosis, there is still a need for public education:

"We want public health messages because, for those who develop the illness, it can be devastating. It can transform people's lives for the worse. People are not going to develop psychosis from having a couple of joints at a party. It's getting involved in daily use that seems to be the riskiest pattern of behavior: we're talking about people who smoke every day and throughout the day."

"When you're faced with a situation where you cannot determine causality, my personal opinion is why not take the safer route rather than the riskier one, and then figure out ways to minimize harm?" said Amir Englund, a cannabis researcher at King's College London.

A UK government spokesperson also said its position on cannabis was clear.

"We must prevent drug use in our communities and help people who are dependent to recover, while ensuring our drugs laws are enforced. There is clear scientific and medical evidence that cannabis is a harmful drug which can damage people's mental and physical health, and harms communities."

These comments underline the need for a global drug policy that prevents drug use, instead of promoting it. Global drug policy should continue to evolve to match the new scientific evidence available, and that includes taking into account the heavy price that increases in drug use entail, particularly in less-developed countries.

###

Prevent. Don't Promote. (http://preventdontpromote.org/) is a global campaign that more than 300 organizations across the world are launching at UNGASS 2016 to support the

UN drug conventions. This consortium of organizations advocates fora global drug policy based on public health and safety through the prevention of drug use and drug problems.

And then read Robert Whitaker's landmark powerful book, "Anatomy of an Epidemic."

Canada’s doctors have been “mind-boggingly cavalier” in prescribing
fentanyl — the most potent narcotic painkiller used outside operating
rooms — and much of the responsibility for the country’s
opioid overdose crisis lies with the medical profession, a leading drug safety researcher is charging.
Dr.
David Juurlink says a new study showing half of all prescriptions for
fentanyl patches are unsafe reflects dangerous prescribing habits and a
serious lack of appreciation for the drug’s toxicity.
Fentanyl has
a strength 100 times that of morphine. Guidelines say no one should be
put on the drug without doctors first trying a less-potent opioid.

But
a study published this week of all patients in Manitoba prescribed
fentanyl patches over 12 years found while prescribing has improved,
half of new prescriptions are still being written for first-time users
with no exposure to opioids.

“It’s very difficult for even a
seasoned pain physician to justify the de novo initiation of fentanyl,”
said Juurlink, head of clinical pharmacology and toxicology at Toronto’s
Sunnybrook Health Sciences Centre.

“The idea that we’re just starting people on fentanyl is mind-boggling.”

He
and others say the study is the latest evidence of a public health
catastrophe the profession, and the public, still hasn’t fully grasped.

More people are dying from opioid overdoses than from car accidents. The medical profession has to take some ownership of this menace.

“This
is a massive social problem and it is heartbreaking to me the extent of
the lack of awareness … that is at least in part a function of some
willful blindness,” said Dr. Gus Grant, president of the Federation of
Medical Regulatory Authorities of Canada.

He said regulators are
seeing loose prescribing, as well as a few malignant doctors “who have
somehow fallen into the sway of the criminal element.”

One Nova
Scotia doctor is alleged to have prescribed more than 50,000 oxycodone
pills to a patient who never received them. On Wednesday, a Toronto
family doctor was arrested in a fentanyl trafficking ring.

Grant
stressed such doctors are outliers. But he also said opioid prescribing
isn’t following the guidelines and, as a result, “we see the ills
associated with these drugs.”

Few people should ever be escalated to taking fentanyl, he maintains,
“because by the time they get to that stage, it’s more likely than not
that they have declared themselves unresponsive to opioids.”
“It’s time to confront the reality of pain management in 2016,” he said. “Opioids don’t work well for a great many patients.”

According
to the federal government’s own projections, Canadian sales of opioids
could exceed $600 million a year by 2019, up from $484 million a decade
ago.

Fentanyl is making up a growing share of that market, as
provinces tighten access to oxycodone — originally known as OxyContin
and one of the most abused drugs in history. OxyContin was replaced in
2012 with a “tamper-resistant” version that becomes a gummy gel when
turned into liquid, making it harder to inject.

However, generic
versions of the original formulation have entered the market. This week,
Ottawa announced the government won’t force the generics to make their
versions of oxy harder to snort or inject, prompting criticism Canada’s
drug-abuse “carnage” will only worsen.

But while the
tamper-resistant formulations are an modest improvement over the older
drug, most abuse happens through the ingestion of intact pills, Juurlink
said.

With fentanyl, it’s through patches — they come in doses of 25 to 100 micrograms.

The
most common form provides three-day continuous drug delivery and has
become a “popular choice” for chronic pain, researchers report this week
in the Canadian Medical Association Journal.
It is also the most
potent opioid prescribed outside hospital. According to Juurlink, people
not only die from exposure to excess levels of fentanyl, but the
combination with many other drugs that are routinely prescribed can
increase its level to lethal ranges.

In
2009-14, there were at least 655 deaths in Canada involving fentanyl,
and more than 1,000 lethal drug poisonings where post-mortem drug
testing detected the presence of fentanyl, says the Canadian Centre on
Substance Abuse.

In Alberta alone, more than 270 people died from fentanyl overdoses last year, double the 2014 toll.
People
are dying not just from illicit street drugs and lethal bootleg
fentanyl from China and other underground markets, but also from
legitimate prescriptions.

Juurlink has treated patients who arrive
in hospital with multiple fentanyl patches, adding up to 400 micrograms
or more. “And it’s almost always the case that they are being made
worse rather than better by the drug,” he said.

“It’s one of the big players right now,” he
said. “They come in with respiratory depression — they’re not breathing
as well. They have drowsiness and altered level of consciousness.”

“We
have physicians who are prescribing these drugs who are not totally
familiar with the delivery system,” he said, “and so the chance for
patients coming with opioid toxicity, or potentially dying, is
definitely there.”

Grant said opioids are important for pain and that doctors need to know how to use them judiciously.
“I
do believe physicians are becoming more rigorous in their prescribing
and I do see that there is an enhanced social awareness of it,” he said.

Endorsement

"All treatment centres in B.C. should get involved and support the Drug Prevention Network. As one collective voice we need to send the message that treatment works and it saves lives. There are recovery houses, treatment centers, private, government funded, long term, short term, detox, therapeutic communities etc. Let's help support prevention and help educate the public."